Provider Demographics
NPI:1609875954
Name:ELKOUSS, GUILLERMO CARLOS (MD)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:CARLOS
Last Name:ELKOUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3319
Mailing Address - Country:US
Mailing Address - Phone:856-912-1040
Mailing Address - Fax:
Practice Address - Street 1:433 DORAL DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3319
Practice Address - Country:US
Practice Address - Phone:856-751-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA033408208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2310104Medicaid
NJ2310104Medicaid
NJ527822DKLMedicare ID - Type Unspecified